No-Fault Case Law
Healthway Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51187(U))
September 15, 2017
The court considered that the plaintiff, Healthway Medical Care, P.C., as an assignee of an individual, was seeking to recover assigned first-party no-fault benefits from the defendant, New York Central Mutual Fire Insurance Company. The main issue that was decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted, based on the fact that the plaintiff's assignor had failed to appear for scheduled independent medical examinations. The court held that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed, with the reasons for the decision stated in another case, Sama Physical Therapy, P.C., as Assignee of Sherod, Hill v New York Cent. Mut. Fire Ins. Co. The decision was made by Justices Pesce, Aliotta, and Solomon.
Sama Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51186(U))
September 15, 2017
The main issue in this case was whether the defendant's motion for summary judgment, which dismissed the complaint of the plaintiff, should be granted. The court considered the fact that the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs), and the proof submitted by the defendant was sufficient to give rise to a presumption that the IME scheduling letters and denial of claim forms had been properly mailed. The court ultimately held that the order granting the defendant's motion for summary judgment was affirmed, with the plaintiff's remaining arguments being deemed moot or lacking merit. Therefore, the defendant's motion for summary judgment was upheld, and the complaint was dismissed.
Fema Med. Supply, Inc. v American Commerce Ins. Co. (2017 NY Slip Op 51160(U))
September 8, 2017
The court considered that in an action by a medical provider to recover assigned first-party no-fault benefits, the plaintiff's motion for summary judgment was denied by the Civil Court. The main issue decided was whether the defendant had failed to deny the claims at issue within the required 30-day period, or whether the defendant had issued timely denials of claim that were conclusory, vague, or without merit as a matter of law. The court held that the plaintiff's motion was properly denied, as they did not demonstrate that the defendant had failed to deny the claims within the required time period or that the denials of claim were conclusory, vague, or without merit as a matter of law. Therefore, the court affirmed the order of the Civil Court.
Chiroworks Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51159(U))
September 8, 2017
The court considered a provider's action to recover assigned first-party no-fault benefits and the defendant's motion for summary judgment dismissing the complaint. The main issue was whether the defendant had submitted sufficient evidence to establish that the plaintiff's assignor had failed to appear for independent medical examinations. The court held that there was no merit to the plaintiff's arguments regarding the sufficiency of the proof submitted by the defendant. Additionally, the court found that the plaintiff's remaining contention lacked merit. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
Island Life Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51157(U))
September 8, 2017
The court considered the motion by defendant State Farm Mutual Automobile Insurance Company for summary judgment to dismiss the complaint filed by Island Life Chiropractic, P.C., as assignee of Blake Brenderline, in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the fees charged by the plaintiff exceeded the amounts permitted by the workers' compensation fee schedule. The court held that the defendant's motion papers failed to establish, as a matter of law, that the fees charged by the plaintiff exceeded the amounts permitted by the workers' compensation fee schedule. As a result, the court reversed the order granting defendant's motion for summary judgment and denied the motion to dismiss the complaint. The decision was made by Judges Pesce, Aliotta, and Solomon, and the order was reversed with costs.
Charles Deng Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51156(U))
September 8, 2017
The court considered the fact that the provider, Charles Deng Acupuncture, P.C., was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The main issue decided was whether the defendant's motion for summary judgment to dismiss the complaint should be granted. The court held that the proof submitted by defendant demonstrated that the plaintiff's assignor had failed to appear for examinations under oath, and therefore affirmed the order granting defendant's motion for summary judgment.
Laga v Country Wide Ins. Co. (2017 NY Slip Op 51155(U))
September 8, 2017
The main issue in this case was whether the denial of claim forms had been properly mailed by the defendant insurance company. The court considered the proof submitted by the defendant in support of its cross-motion, which was found to be sufficient to give rise to a presumption that the denial of claim forms had been properly mailed. The plaintiff's argument with respect to the defendant's cross-motion was also considered, but ultimately not properly before the court as it was being raised for the first time on appeal. As a result, the court affirmed the order, denying the plaintiff's motion for summary judgment and granting the defendant's cross-motion for summary judgment dismissing the complaint.
Acupuncture Now, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51154(U))
September 8, 2017
The court considered the plaintiff's appeal from an order by the Civil Court granting the defendant's motion for summary judgment dismissing the first through fifth causes of action and compelling the plaintiff to appear for a deposition. The main issue decided was whether the defendant's fee reductions, according to the workers' compensation fee schedule for acupuncture services performed by chiropractors, were proper. The court held that it is legal for an insurer to use the workers' compensation fee schedule to determine the amount a licensed acupuncturist is entitled to receive for acupuncture services. Furthermore, since the defendant was defending the remaining cause of action on the grounds that the services rendered lacked medical necessity, the Civil Court properly granted the defendant's motion to compel the plaintiff to appear for a deposition. Thus, the order was affirmed.
525 EVM, Inc. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51153(U))
September 8, 2017
The relevant facts the court considered were that 525 EVM, Inc., as the assignee of Dzianis Haiduk, was seeking to recover assigned first-party no-fault benefits from GEICO General Insurance Company. The main issue was whether there were triable issues of fact regarding the summary judgment motion and cross-motion for summary judgment. The holding of the court was that the Civil Court properly denied both motions and found that there were triable issues of fact. The Appellate Term affirmed the decision, declining the plaintiff's request to limit the issues for trial. Therefore, the order was affirmed, and the case was allowed to proceed to trial.
Gentlecare Ambulatory Anesthesia Servs. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51152(U))
September 8, 2017
The court considered the facts that the plaintiff, Gentlecare Ambulatory Anesthesia Services, was seeking to recover assigned first-party no-fault benefits from the defendant, State Farm Mutual Automobile Insurance Company. The defendant had moved for summary judgment to dismiss the complaint on the grounds that the plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs). The main issue decided was whether the defendant’s proof that the EUO scheduling letters and denial of claim forms had been timely and properly mailed was sufficient. The court ultimately held that there was no merit to the plaintiff’s arguments regarding the sufficiency of the defendant’s proof, and affirmed the order granting the defendant’s motion for summary judgment. The decision was made by Judges Pesce, Aliotta, and Solomon.